Effect of Lactobacillus sakei supplementation in children with atopic eczema–dermatitis syndrome

doi:10.1016/j.anai.2010.01.020

Annals of Allergy, Asthma & Immunology

Volume 104, Issue 4, April 2010, Pages 343-348

https://doi.org/10.1016/j.anai.2010.01.020 Get rights and content

Background

Probiotics have been suggested to be useful in children with atopic eczema–dermatitis syndrome (AEDS).

Objective

To assess the clinical effect of Lactobacillus sakei supplementation in children with AEDS.

Methods

In a double-blind, placebo-controlled trial, children aged 2 to 10 years with AEDS with a minimum SCORing of Atopic Dermatitis (SCORAD) score of 25 were randomized to receive either daily L sakei KCTC 10755BP or daily placebo supplementation for 12 weeks. Changes in SCORAD scores and serum chemokine levels from baseline were evaluated.

Results

Eighty-eight children were enrolled, and 45 were allocated to probiotic treatment. Seventy-five children completed the study, with 4 dropouts in the probiotic group and 9 in the placebo group. At week 12, SCORAD total scores adjusted by pretreatment values were lower after probiotic treatment than after placebo treatment (P = .01). There was a 31% (13.1-point) improvement in mean disease activity with probiotic use compared with a 13% (5.2-point) improvement with placebo use (P = .008). Significant differences in favor of probiotic treatment were also observed in proportions of patients achieving improvement of at least 30% and 50%. Compared with placebo, probiotic administration was associated with lower pretreatment-adjusted serum levels of CCL17 and CCL27 (P =.03 for both), which were significantly correlated with SCORAD total score (r = 0.59 and 0.63, respectively; P < .001).

Conclusions

Supplementation of L sakei in children with AEDS was associated with a substantial clinical improvement and a significant decrease in chemokine levels, reflecting the severity of AEDS.

Introduction

Atopic eczema–dermatitis syndrome (AEDS) is a common chronic inflammatory skin disease that can be complicated by recurrent skin infections.¹ The increase in prevalence and the clinical challenge of management have highlighted the need to develop new therapeutic approaches to control AEDS. Based on the knowledge of potential benefits from modification of the gastrointestinal flora, obvious interests in the preventive and therapeutic role of probiotics in AEDS have been aroused. In particular, results of population-based studies2, 3 suggest that childhood enteric infection and increased exposure to bacteria are protective against allergies, facilitating the clinical trial of probiotics for the management of AEDS.

Because rapid colonization occurs in the first year of life until a stable gut microflora is established,⁴ most previous studies examined the effect of early probiotic supplementation. Perinatal administration of probiotics to at-risk infants halved the subsequent occurrence of AEDS in IgE-independent mechanisms.5, 6 Probiotics were also shown to reduce the severity of AEDS when administered to infants with early-onset AEDS,7, 8, 9 although other clinical trials10, 11 have not shown AEDS-related benefits of probiotic supplementation during infancy. In contrast, only a few clinical trials have evaluated the effectiveness of probiotics on older children with established AEDS. In these trials,12, 13, 14 the administration of probiotics to children 1 year and older seems able to improve the manifestations of AEDS.

The purpose of this study was to evaluate the clinical efficacy in AEDS of a newly identified probiotic strain, Lactobacillus sakei KCTC 10755BP, which showed the most potent inhibitory activity against Staphylococcus aureus growth among Lactobacillus species in a preliminary experiment. We administered L sakei to an unselected group of children aged 2 to 10 years with moderate and severe AEDS and evaluated the clinical outcome at the end of the intervention. In addition, we also measured levels of serum chemokines as activity markers for AEDS to provide more objective evidence for the beneficial role of this probiotic.

Section snippets

Patients and Study Design

Children aged 2 to 10 years were recruited between January 1, 2007, and August 31, 2008, to study the effects of the probiotic on AEDS symptoms at the Department of Pediatrics, Chungbuk National University Hospital. AEDS was defined as a pruritic chronic or chronically relapsing noninfectious dermatitis with typical features and distribution as suggested by Hanifin.¹⁵ The inclusion criteria were AEDS present for at least 6 months, a SCORing of Atopic Dermatitis (SCORAD) total score greater than

Study Population

Of the 107 individuals who were screened, 88 met the entry criteria and were randomized to treatment, 45 to the probiotic group and 43 to the placebo group (Fig. 1). Of these patients, 13 were withdrawn because of refusal to ingest the powder, nonattendance at scheduled visits, poor compliance, and ingestion of other probiotic agents. No significant differences in dropout rates were observed between the groups (P = .11). Compliance was good, with 91% of doses administered and no difference

Discussion

Current evidence is more convincing for the efficacy of probiotics in the prevention rather than the treatment of AEDS.²⁰ However, despite the mixed results in clinical trials7, 8, 9, 10, 11 evaluating the therapeutic potential of probiotics during infancy or childhood including infancy, data in clinical trials12, 13, 14 for the treatment of established AEDS seem to be favorable in children older than 1 year. We also examined the beneficial role of probiotics in older children aged 2 to 10

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Citation Excerpt :
The doses, duration, and concentrations of probiotics were very wide. Some of the most representative studies are summarized in Table VIII.82,120,122 The analysis found little or no difference for a reduction in SCORing Atopic Dermatitis (SCORAD), no difference for patient-reported outcomes, and no evidence for a difference in quality of life.
The microbiome plays an important role in the pathogenesis of allergic diseases. This review updates the reader on studies aimed at influencing allergic diseases through modulation of the gut microflora. A nonsystematic review of the literature was performed, focusing on relevant trials evaluating the effect of probiotics/prebiotics/symbiotics in the prevention and treatment of allergic disease. For each allergic disease, we were able to find not only a substantial number of clinical trials but also systematic reviews. Specific guidelines, based on systematic reviews and meta-analyses, are available for the prevention of allergic disease and for the treatment of food allergy. In each of the areas examined—allergic rhinitis, allergic asthma, atopic dermatitis, food allergy, and gastrointestinal allergies—there are substantial uncertainties in the efficacy of gut microflora modulation in prevention and treatment. At present, practicing clinicians can avail themselves of intestinal flora modulators as an adjunct in the prevention of atopic dermatitis but not of other forms of allergic diseases. Their effects on the treatment of allergic diseases remain controversial.
Probiotics to Reduce the Severity of Atopic Dermatitis in Pediatric Patients: A Systematic Review and Meta-Analysis
2021, Actas Dermo-Sifiliograficas
Los probióticos, definidos como microorganismos vivos que proveen un beneficio para la salud del huésped, se han propuesto como una opción terapéutica para la dermatitis atópica (DA), habiéndose identificado varios mecanismos de acción. Se evaluó la eficacia del uso de probióticos para disminuir la gravedad de dermatitis atópica en pacientes pediátricos menores de 18 años.
Se realizó una revisión sistemática y metaanálisis que incluyó ensayos clínicos aleatorizados en pacientes menores de 18 años con diagnóstico establecido de dermatitis atópica, cuya gravedad estuvo medida por el Scoring Atopic Dermatitis (SCORAD) comparando el efecto de probióticos con el placebo, mediante la investigación en bases de datos MEDLINE, Web Of Science (WOS), Scopus, ClinicalTrials.gov, Epistemonikos, Trip medical database, Biblioteca virtual en salud (BVS).
Se obtuvieron 20 estudios que fueron incluidos en la revisión sistemática, de los cuales 16 apoyan el uso de probióticos para reducir la gravedad del SCORAD en la dermatitis atópica. En el metaanálisis se obtuvo como resultado global una diferencia de medias de −0,38, con un IC 95% de −0,63 a −0,14, a favor del uso de probióticos; sin embargo, se encontró una alta heterogeneidad en los estudios debido a la variabilidad clínica y metodológica, con un I² = 76%.
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Probiotics, defined as live microbial dietary supplements that provide health benefits for the host, have been suggested as a treatment for atopic dermatitis based on a variety of proposed mechanisms of action. We analyzed evidence for the efficacy of probiotics to attenuate the severity of atopic dermatitis in pediatric patients younger than the age of 18 years.
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Twenty trials were retrieved and included in the systematic review. Sixteen supported the use of probiotics to attenuate SCORAD-evaluated severity. Meta-analysis found an overall mean difference in effect between probiotics and placebo of −0.38 (95% CI, −0.63 to −0.14) in favor of probiotics. However, trial heterogeneity was high (I² statistic, 76%) due to clinical and methodological variability.
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: Disclosures: Authors have nothing to disclose.

: Funding Sources: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (2010-0001271).

: Trial Registration:clinicaltrials.gov Identifier: NCT00893230.

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Original articleInterventionEffect of Lactobacillus sakei supplementation in children with atopic eczema–dermatitis syndrome

Background

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Patients and Study Design

Study Population

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

Lancet

Lancet

J Allergy Clin Immunol

Pediatr Clin North Am

Lancet

J Allergy Clin Immunol

J Allergy Clin Immunol

Exposure to foodborne and orofecal microbes versus airborne viruses in relation to atopy and allergic asthma: epidemiological study

BMJ

Functional food science and gastrointestinal physiology and function

Br J Nutr

Probiotics in the management of atopic eczema

Clin Exp Allergy

Probiotics in the treatment of atopic eczema/dermatitis syndrome in infants: a double-blind placebo-controlled trial

Allergy

Effects of probiotics on atopic dermatitis: a randomised controlled trial

Arch Dis Child

Original article
Intervention
Effect of Lactobacillus sakei supplementation in children with atopic eczema–dermatitis syndrome